Right Ventricular Failure Following Left Ventricular Assist Device Implantatation; the Myth Is in the Management

Abstract

Purpose Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a controversial complication. Many institutions report high rates of RVF after LVAD implantation, and have sought to predict RHF preoperatively so that they are able to support the right heart post operatively, often using a temporary right ventricular assist device. We describe our methods to minimize RVF post LVAD implantation at this institution. Methods and Materials We retrospectively analyzed LVAD recipients implanted at our institution between July 2006 through August 2012. Clinical outcomes were examined. RVF was defined as inotropic use greater than 7 days post operatively, the use of right ventricular mechanical support, and pulmonary vasodilator usage. Results 130 LVADs were implanted during the period from July 2006 to August 2012, 107 male and 23 female patients. The mean age was 60 ± 11, and total duration of support was 349 days, ± 348. There were 113 Thoratec® HeartMate II LVAD’s implanted, and 17 HeartWare® LVAD’s implanted. Of the 130 patients evaluated, 12 developed RVF following LVAD (9%). Mean pre operative CVP was measured at 14 ± 7 and mean right ventricular stroke work index (RVSWI ) was 0.522 ± 0.32. 20 out of 130 patients were considered to have severe TVR. 95% of the patients were supported with inotropic support preoperatively. We found that the only significant predictor of post operative right heart failure was that of elevated CVP, with p = 0.28. No patients required RVAD support post operatively. Conclusions In our experience, patient selection and pre, intra, and post operative management of the right heart is likely the most essential aspect in preventing RHF in the LVAD population of patients. Paramount for this type of therapy to continue to be a viable treatment option for end stage heart failure patients is the ability to maintain low complication rates post implantation; not just for optimal patient quality of life, but for economic sustainability.